Long-term COVID-19 effects on the lungs, heart and brain: What experts say they know, and don't know

Dubai: Most people who had been infected with COVID-19 recover within 14 days. But there are those who report brain fog, palpitations, constant tiredness, mood swings — up to 95 days after the onset of symptoms.

This was reported in the The Lancet quoting Paul Garner, a professor of epidemiology at Liverpool School of Tropical Medicine, UK. “I am unable to be out of bed for more than three hours at a stretch, my arms and legs are permanently fizzing as if injected with Szechuan peppercorns, I have ringing in the ears, intermittent brain fog, palpitations, and dramatic mood swings,” Garner wrote about his own experience with COVID.

Many others had similar complaints: the medical journal reported that 78 of 100 patients in an "observational cohort" study who had recovered from COVID-19 had abnormal findings on cardiovascular MRI (median of 71 days after diagnosis) and 36 of those reported dyspnoea and unusual fatigue.

Neurological symptoms

Neurological symptoms are "extremely common" among coronavirus patients who had been hospitalised, said clinical researchers. The study, published on October 5, 2020 in the Annals of Clinical and Translational Neurology was led by Eric Liotta of the Department of Neurology of the Northwestern University Freinburg School of Medicine.

Citing patient data, they found that symptoms (from mild to severe) can include headaches, dizziness and "altered brain function". The findings highlight the coronavirus' wide-ranging effects on the human body. Many of their patients continued to experience these symptoms long after they recovered from the disease, researchers reported.

I am unable to be out of bed for more than three hours at a stretch, my arms and legs are permanently fizzing as if injected with Szechuan peppercorns, I have ringing in the ears, intermittent brain fog, palpitations, and dramatic mood swings.

- Paul Garner, a professor of epidemiology, as quoted by The Lancet

In the study, Dr Liotta's team reviewed medical records of the first 509 patients hospitalised within their network of 10 hospitals and medical centers in Chicago, Illinnois, in March and April 2020. About 1 out of 4 had been put on ventilators.

One startling result: A majority of 509 patients — 82% — developed problems stemming from the nervous system. "That means 4 out of 5 hospitalised patients in our hospital system at the beginning of the pandemic had those neurologic problems," said Dr. Igor Koralnik, a co-author of the study and chief of neuro-infectious diseases and global neurology at Northwestern University (NU). Muscle pain was reported by nearly 44.8% of patients, and 37.7 percent complained of headaches.

One out of three patients developed a more serious type of neurological problem: encephalopathy — altered brain function. Problems ranged from mild symptoms, such as difficulty with attention, short-term memory, concentration and multitasking abilities, "all the way to confusion, stupor and coma," Koralnik said.

Many patients in the hospital with COVID complained of muscle aches, and loss of smell and taste. Those are reversible, and benign. But more than these, the NU data show that neurological manifestations are also common, even if often mild. However, more severe brain-function issues were more likely to occur in older patients over 65, the researchers reported.

The WHO clarified that these rather concerning effect happens in fewer than 5% of total infections. The world body reports that more than 80% do recover from the disease without needing special treatment. For the vast majority – especially children and young adults – illness due to COVID-19 is generally minor. The outcome vastly differs for some “immuno-compromised” persons (those who are over 60 years, and with underlying medical conditions such as diabetes, heart disease, respiratory disease or hypertension), who can face serious illness.

Among those who face severe COVID-19 cases, it mainly affects the lungs. But recent research also show the heart and brain bear the disease’s brunt.

Heart damage

One effect of COVID-19 now known to clinicians is the disease's ability to make blood cells more likely to clump up and form clots. While large clots can cause heart attacks and strokes, much of the heart damage caused is believed to stem from very small clots that block tiny blood vessels (capillaries) in the heart muscle. Blood clots are also known to damage the lungs, legs, liver and kidneys. Coronavirus can also weaken blood vessels — against contributing to potentially long-lasting problems with the liver and kidneys.

This raises the risk of long-term health problems, say experts. And it’s only now that clinicians are starting to get data on the pandemic’s long-term effects. As the contagion unfolds, one health effect that the US Centres for Disease Control and Prevention (CDC) is closely watching and working to understand relates to COVID-19's knock-on effect on heart.

One effect of COVID-19 now known to clinicians is the disease's ability to make blood cells more likely to clump up and form clots. Large clots can cause heart attacks and strokes. However, much of the heart damage caused is believed to stem from very small clots that block tiny blood vessels (capillaries) in the heart muscle. Blood clots are also known to damage the lungs, legs, liver and kidneys. Coronavirus can also weaken blood vessels — against contributing to potentially long-lasting problems with the liver and kidneys.

Heart conditions associated with coronavirus infection include inflammation and damage to the heart muscle itself (also known as myocarditis) or inflammation of the covering of the heart (called pericarditis). “These conditions can occur by themselves or in combination.”

“There are many ways the infection can affect someone’s health,” the CDC states in its September guidance on long-term effects of COVID, adding that the long-term effects are yet" unknown".

“Heart damage may be an important part of severe disease and death from COVID-19, especially in older people with underlying illness. Heart damage like this might also explain some frequently reported long-term symptoms like shortness of breath, chest pain, and heart palpitations. The risk of heart damage is not limited to older and middle-aged adults. “For example, young adults with COVID-19, including athletes, can also suffer from myocarditis. Severe heart damage has occurred in young, healthy people – but is rare,” CDC's September 2020 guidance states.

Effects on the brain

If there’s anything definite about COVID’s effect on people over time, it’s the fact that it remains unknown. Mayo Clinic researchers recommend that doctors closely monitor people who have had COVID-19 to see how their organs are functioning after recovery.

Clinical test results now emerging also show more cases of mild effects of COVID-19. To know the disease's effects on the heart, doctors resort to special imaging tests, including in younger people with mild or minimal symptoms. "We are seeing patients in clinics dedicated to COVID-19 convalescents, and for some of these patients the return to their former health trajectory is slow and painful. These patients are not only those recovering from the severe form of the acute disease (ie, post intensive care syndrome), but also those who had mild and moderate disease," The Lancet reported.

What's the best way I can do to prevent COVID

The best strategies for preventing COVID-19 infection among ordinary people, especially youth and adults, are:

Correlation

Often, people who survived severe symptoms of COVID-19 following a stay in the hospital (often with assistance such as ventilators to breathe) are traumatised by the experience. Experts say that survivors of severe COVID later develop post-traumatic stress syndrome, depression and anxiety.

COVID-19 had been with us only 10 months. Because it's difficult to predict long-term outcomes from the relatively new virus, scientists are looking at the long-term effects seen in related viruses, such as severe acute respiratory syndrome (SARS-CoV-1).

Chronic fatigue syndrome is a complex disorder manifesting through extreme fatigue that worsens with physical or mental activity — and doesn't improve with rest — a condition faced by people who had recovered from SARS. Experts now hypotheise the same may be true for people who have had SARS-CoV-2.